Experience & Desire

Breast Reconstruction Irvine

Dr. Smith is devoted to helping women win the battle against breast cancer. He is part of a highly skilled surgical team that treats women in all stages of cancer diagnosis. To learn more about the techniques Dr. Smith uses for breast reconstruction in Orange County, visit his surgical specialty site: www.OrangeCountyBreastReconstruction.com

Breast reconstruction after mastectomy is one of the most complex and rewarding procedures a plastic surgeon performs. Dr. Andrew Smith has earned a reputation as one of the top Orange County breast reconstruction surgeons – not just for his skill, but for his dedication to his patients and his passion for excellent results. His high degree of specialized training in this area, combined with new techniques in breast reconstruction, make it possible for women to have breasts that look and feel natural, even after mastectomy or lumpectomy.

If you or a loved one have questions about breast reconstruction, request a FREE surgical consultation with Dr. Smith. He will set aside as much time as is necessary to answer all of your questions. You can also call our Irvine, Huntington Beach and Corona plastic surgery offices at (949) 653-7000.

When you choose Dr. Smith, you’re choosing a breast specialist who

Is the Chief of the Subsection of Plastic Surgery at Saddleback Memorial Medical Center

Is one of the top surgeons in Orange County for complex breast revisions and reconstructions

Has performed thousands of breast surgeries during his 15+ years of surgical experience

What Breast Reconstruction Can Do for You

Breast reconstruction is the process of restoring a breast (or breasts) to a natural appearance after cancer or other disease has resulted in mastectomy or lumpectomy. It is an excellent option for women who:

Have had a mastectomy or lumpectomy at an earlier date and are now ready for reconstruction

Are planning to undergo mastectomy or lumpectomy and want immediate reconstruction (at the time of their cancer surgery)

Whose cancer treatment is at a stage that allows them to safely undergo reconstruction

Breast reconstruction can be performed using a breast implant or your own tissue to replace the lost breast.

Insurance Coverage for Breast Reconstruction

Most women who have health insurance and have undergone or are planning to undergo mastectomy are eligible for insurance coverage of their breast reconstruction procedure. In fact, Federal law requires that in most cases your insurance carrier cover the reconstruction. Dr. Smith and his office staff can check on your insurance coverage and help you with any necessary paperwork. With so much on your mind during breast cancer treatment, Dr. Smith believes you should not have to spend a lot of time worrying about paying for your procedure and hoping it will be covered by insurance.

Check your policy to make sure you’re covered and to see if there are any limitations on what types of reconstruction are covered. Also, get educated about the law so you know your rights when it comes to insurance coverage of breast reconstruction.

Before & After Photos

WARNING: This feature contains nudity. Please click OK to confirm you are at least 18 years of age and are not offended by such material.

Before

After

Case 241, Breast Reconstruction

44 year-old female before and after mastectomy and reconstruction. Immediate placement of a 450cc silicone gel impants and alloderm.

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After

Case 247, Breast Reconstruction

35 year-old female before and after mastectomy and reconstruction. Immediate placement of a tissue expander and alloderm followed by placement of a silicone gel implant.

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After

Case 239, Breast Reconstruction

51 year-old female before and after mastectomy and reconstruction. Immediate placement of a tissue expander and alloderm followed by placement of a 550cc silicone gel implant.

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After

Case 39, Breast Reconstruction

This 50-year-old breast cancer patient knew she was going to need a mastectomy, and decided to find out about options for immediate breast reconstruction. She scheduled a consultation with Dr. Smith to get his opinion on her options for breast reconstruction in California.Dr. Smith recommended a breast augmentation using an implant and expander, so he and the patient spent some time deciding on the right implant size and shape to create the full, balanced, and natural appearance she wanted.
The patient’s surgical procedure required several steps, beginning with an areola-sparing mastectomy and immediate placement of a tissue expander, a temporary implant that Dr. Smith would eventually repl…

Before

After

Case 238, Breast Reconstruction

33 year-old female before and after mastectomy and reconstruction. Immediate placement of a tissue expander and alloderm followed by placement of a 650 cc Silicone gel implant.

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After

Case 242, Breast Reconstruction

48 year-old female with history of left breast cancer. Patient before and after mastectomy and reconstruction. Immediate placement of a tissue expander and alloderm followed by placement of a silicone gel implant on left and to the right for symmetry purposes. Patient also had reconstruction to left nipple / areola.

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After

Case 244, Breast Reconstruction

49 year-old female before and after mastectomy and reconstruction. Immediate placement of a tissue expander and alloderm followed by placement of a silicone gel implant.

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After

Case 248, Breast Reconstruction

45 year-old female before and after mastectomy and reconstruction. Patient has chosen direct to implant reconstruction. Placement of a 250cc silicone gel implant with alloderm.

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After

Case 240, Breast Reconstruction

51 year-old female 5’6 135lbs before and after mastectomy and reconstruction. Immediate placement of a tissue expander and alloderm followed by placement of a 457cc silicone gel implant and bilateral capsulectomy.

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After

Case 237, Breast Reconstruction

44 year-old female before and after mastectomy and reconstruction. Immediate placement of a tissue expander and alloderm followed by placement of a silicone gel implant.

See More Before & After Photos

Surgical Considerations

Depending on your state of mind, you may begin planning for your reconstruction as soon as you learn that you will be undergoing mastectomy. Your breast surgeon and your plastic surgeon will work together in planning an approach that ensures your health and the best possible outcome.

Dr. Smith will take into consideration your health, your anatomy, and your goals, then will discuss all of your options with you. Your needs are his top priority, and he will listen to you and help you to have realistic expectations from your procedure.

Where Will You Have Your Surgery?

It is not uncommon for breast reconstruction to take place in stages. The first stage is usually performed in a hospital. Dr. Smith operates at Saddleback Memorial Medical Center, Orange Coast Memorial Medical Center, and Irvine Regional Hospital. An overnight stay is common after a mastectomy and immediate reconstruction.

Secondary surgeries are usually outpatient procedures. This may be at either one of the above hospitals or at the Laguna Hills Surgery Center.

Types of Implants

For many patients, breast implants are a good option for breast reconstruction. You will have your choice of several shapes and sizes, as well as silicone or saline-filled.

The Surgery

You have several options for post-mastectomy breast reconstruction. Dr. Smith will thoroughly discuss the options available to you at your consultation.

The 2 types of reconstruction currently available can be divided into implant-based reconstruction and reconstruction that uses your own tissue (flap reconstruction).

Implant Reconstruction

For many women, implant reconstruction with tissue expanders is the best option. The tissue expander is put in place at the time of mastectomy, and adds a small amount of immediate volume. The tissue expander is gradually filled with saline solution at regular intervals over a period of weeks or months. This allows the skin and tissue to expand, making room for the placement of a breast implant. During a second procedure, the tissue expander is removed and a more permanent breast implant is inserted. Depending on the type of mastectomy, you may need to have your nipple-areolar complex reconstructed in a separate procedure.

Flap Reconstruction

Dr. Smith is one of an elite group of plastic surgeons who can reconstruct the breast mound using tissue taken from other areas of the body such as the abdomen, back, or buttocks. There are numerous types of “flap” procedures, all of which require extensive training and skill. Since the tissue must remain attached – or be reattached – to blood vessels, expertise in microvascular surgery is required for this type of surgery.

The downside of flap reconstruction is that recovery is longer, and there will be scars at both the donor and recipient sites. However, using your own tissue produces a natural look and feel, and comes with none of the concerns associated with implants. Dr. Smith will help you determine if this approach is right for you.

Risks and Complications

Most women who must lose a breast to cancer can have it rebuilt through reconstructive surgery. However, there are certain risks associated with any surgery and complications that are specific to this procedure.

There are general problems such as bleeding, fluid collection, infection, excessive scar tissue, or difficulties with anesthesia which can occur, although they’re relatively uncommon. As with any surgery, smokers should be advised that nicotine can delay healing and smoking should be stopped prior to surgery.

Implant specific problems also can occur. The most common of these problems is called capsular contracture. This can occur if the scar or capsule around the implant begins to tighten. This squeezing of the soft implant can cause the breast to feel hard. This may be treated in several ways, including either removal or releasing the scar tissue or sometimes replacing the implant.

Reconstruction has no effect on the recurrence of cancer. It also does not interfere with chemotherapy or radiation treatment, which is sometimes needed after surgical treatment of breast cancer.

Dr. Smith will recommend continuation of periodic mammograms on both the reconstructed and the remaining normal breast. If your reconstruction involves an implant, be sure to go to a radiology center where technicians are experienced in the special techniques required to get a reliable x-ray of a breast reconstructed with an implant.

Delayed Breast Reconstruction

Women who postpone reconstruction may go through a period of emotional readjustment. Just as it took time to get used to the loss of a breast, a woman may feel anxious and confused as she begins to think of the reconstructed breast as her own.

Still, there are some legitimate reasons to delay reconstruction until a later date. Some women are not comfortable weighing all the reconstructive options while they are struggling to cope with a diagnosis of cancer. Others simply do not want to have any more surgery than is absolutely necessary. Women with other health conditions, such as obesity, high blood pressure, or smoking, may also be advised to wait.

Your Recovery and Beyond

You will probably spend 1 or 2 days in the hospital following your surgery. Fatigue and soreness are the most common complaints following breast reconstruction surgery. Dr. Smith will prescribe pain medication to manage your discomfort. You will likely have a surgical drain in place for about 7 to 10 days to prevent fluid accumulation at the surgical site. We use dissolvable sutures that do not need to be removed.

Women who choose immediate reconstruction at the time of mastectomy may require 6 weeks of recovery time. Flap reconstruction requires a longer recovery than reconstruction with implants. Dr. Smith and his caring staff will be available to you around the clock during your recovery to answer any questions that arise.

Although you may never regain full sensation in your breast, you may regain some feeling over time. Your scars will fade over the course of several months or years.

If you need to have subsequent procedures, such as reconstruction of your nipple-areolar complex, areolar re-pigmentation, or surgery on the other breast for symmetry, Dr. Smith and his staff will address those concerns when the time is right.

Where to Begin

If you are facing mastectomy, you will need to process a lot of new information and make many important decisions in a short period of time. Board-certified plastic surgeon Dr. Andrew Smith specializes in breast reconstruction for his Orange County, California patients. Together with his helpful and caring office staff, Dr. Smith makes an effort to educate and support patients through this difficult time.Dr. Smith will help educate you and answer your breast reconstruction questions when you meet with him at your consultation. He understands that it is important to trust and be comfortable with your surgeon during this stressful and confusing time.

Timing

After choosing breast reconstruction, our Orange County patients must decide whether to have their reconstruction performed at the time of a mastectomy (immediate reconstruction) or at a later date (delayed reconstruction). Both of these techniques have their own unique potential advantages.Immediate Reconstruction
The vast majority of Dr. Smith’s Orange County breast cancer patients choose immediate reconstruction. Immediate reconstruction avoids a separate surgery for the first stage of reconstruction because it can be started at the time of the mastectomy. Scar tissue does not have a chance to build up when the reconstruction is immediate. Also, Dr. Smith has found that having a breast mound in place immediately after mastectomy has a tremendous psychological benefit for most patients. Using AlloDerm® during implant reconstruction has made this aspect of immediate reconstruction even more compelling.Delayed Reconstruction
The main advantage of delayed reconstruction, especially for more advanced cases, is that the patient’s breast cancer can be treated completely prior to the reconstruction. Delaying the reconstruction also can be appropriate for patients who are undecided about whether they want to undergo reconstruction at all, or are unsure of the type of reconstruction to choose.

Technique

Breast reconstruction is the process of rebuilding a woman’s breast after mastectomy. This procedure is performed by a plastic surgeon, such as Dr. Andrew Smith, who is a breast reconstruction specialist. Our Orange County patients who choose breast reconstruction must also choose the reconstruction method that is best for their needs:

Implant reconstruction is the most common form of breast reconstruction in Dr. Smith’s Orange County practice. This technique typically involves the placement of a tissue expander (adjustable implant) at the time of the mastectomy. A second outpatient surgery is needed to remove the tissue expander and place a more permanent implant.

Flap reconstruction involves reconstructing the breast using tissue transplanted from another area of the body. The most common flap reconstructions are TRAM flaps and latissimus flaps.

Nipple and areola reconstruction is the final phase of breast reconstruction. Although this phase of reconstruction is optional, it can add an important finishing touch to enhance the final appearance of the breast.

At your personal consultation, Dr. Smith will describe the various options available and help you decide which is most appropriate for you. Dr. Smith and his staff make it a priority to educate, support, and guide you through this very stressful time.

“I Have Breast Cancer”

For women worldwide and right here in Orange County, breast cancer brings an almost innumerable list of complications and challenges to a woman’s life. It is comforting to know that with modern treatments and drug therapies, breast cancer is by no means a terminal diagnosis for most women. At the same time, a cancer diagnosis can be a shock to the system, in almost all cases causing women to worry about what treatment will be like and what the future may hold.You have so much to consider as you weigh your options. If mastectomy is your recommended treatment, it is only natural to wonder what you can do to minimize the physical reminders of breast cancer. Dr. Andrew Smith is an Orange County breast surgeon who understands the stress of envisioning your life after breast cancer because he has been a part of the treatment team for many patients just like you.

Dr. Smith created this site to help provide detailed information and other resources that can help relieve some of the fear and worry so that you can make good choices for your health and happiness. He is available to talk with you and your cancer treatment team – contact him online to take the next step.

“I’ve Undergone Mastectomy”

For many of our patients in Orange County, breast cancer diagnosis and the period immediately following can be overwhelming and confusing. In this hectic time, many women are not provided with information about reconstructing a breast lost to cancer, since this topic is often considered secondary to life-saving breast cancer treatment.Other women are told about their breast reconstruction options, but feel that having immediate breast reconstruction following mastectomy is too much too soon. No matter your reasons, you are now considering breast reconstruction and Orange County breast surgeon Andrew Smith, MD, FACS is dedicated to helping you understand your options completely so that you can decide whether reconstruction fits with your priorities following mastectomy.

In his years as a board-certified plastic surgeon, Dr. Smith has performed both immediate and delayed breast reconstruction, successfully working with other medical professionals in a patient’s treatment team to create satisfying results and help women “move on” from their cancer diagnosis.

“A Loved One in My Life has Breast Cancer”

If you have a mother, wife, sister, friend, or other loved one in your life who is facing a breast cancer diagnosis, there’s a lot to learn before you can feel comfortable helping them to understand their options. In addition to the many breast cancer resources available on the Web – including information on mastectomy and lumpectomy – this site provides detailed information about the next stage after mastectomy for many women: breast reconstruction.Breast reconstruction involves a plastic surgeon recreating the form and appearance of a lost breast. The decision to choose breast reconstruction is ultimately a very personal one and while your support and guidance will help the woman in your life face her diagnosis head-on, you should be careful to make sure she is making a decision for herself that is right for her needs. There is no “right” or “wrong” answer when it comes to choosing (or not choosing) breast reconstruction.

About Breast Reconstruction

If you are facing mastectomy, you have many important decisions to make. One of the first decisions is whether or not to choose breast reconstruction. Breast reconstruction in Orange County, California recreates a breast that has been removed due to cancer, trauma, or other disease. Dr. Andrew Smith is a breast surgeon who strives to create results that look and feel as much like your natural breast as possible. The nipple and areola can be reconstructed in a separate minor procedure as well.

Who is a Candidate?

Many mastectomy patients choose to have their breast reconstructed, which can restore their body shape and improve their self-image. However, breast reconstruction is not the right choice for every woman who has a mastectomy. It might not be a good choice for you if you smoke, are obese, or have significant health problems like diabetes or heart disease.

In general, most mastectomy patients are candidates for “immediate breast reconstruction,” which is performed at the time of the mastectomy. It can be an appropriate option for many of our Orange County breast surgery patients who have early-stage cancer that is likely to be eliminated from the mastectomy.

Choosing “delayed reconstruction,” which takes place sometime after the initial treatment, is the right option for some women. This can be a more appropriate option for patients who have advanced cancer, had previous radiation to the chest wall, or have medical issues prohibiting a long surgical procedure.

Insurance & Breast Reconstruction

Most mastectomy patients who have health insurance are eligible for coverage of their breast reconstruction in Orange County, California. In fact, Federal law requires that in most cases your insurance carrier cover the reconstruction. This coverage is not limited to the breast with cancer, but also includes procedures on the non-cancerous breast as well. For example, some patients require surgery to achieve symmetry between the reconstructed breast and the non-cancerous breast, while others choose to have the non-cancerous breast removed and reconstructed as well.Help with the Insurance Process
Dr. Andrew Smith and his office staff understand that undergoing mastectomy and breast reconstruction in Southern California can be very stressful. Our office staff is happy to help you with the pre-approval process required by many insurance plans and assist you with any necessary paperwork. We will also help you review your policy and determine if there are any limitations on the types of reconstruction that are covered.

Surgical Techniques

If you are facing mastectomy, you have many important decisions to make. One of the most significant decisions is whether or not to have your breasts reconstructed. Orange County breast surgery with Dr. Andrew Smith creates results that look and feel as much like a natural breast as possible. After mastectomy, it can be mentally healing to enhance your self-image and sense of femininity through this commonly chosen procedure.

Tissue Expansion

Tissue expansion is the most popular breast reconstruction technique for our Irvine and Corona, California patients. After mastectomy, Dr. Smith places a temporary, adjustable tissue expander below the pectoral, or chest, muscle in order to stretch out the muscle and skin, making a pocket for a permanent breast implant. The tissue expander can be placed at the time of the mastectomy in what is called an immediate reconstruction. Many of Dr. Smith’s Orange County breast reconstruction patients choose tissue expanders – click here to read Teri’s breast surgery story for more details about this method.Using AlloDerm®
Although the expansion process can take several months, newer techniques have greatly reduced the process. During the initial surgery, a mesh called AlloDerm® can be used to create a pocket below the muscle for placement of the tissue expander. Using AlloDerm can allow more fluid to be placed in the expander, thereby reducing the overall duration of the expansion process in the office. It also can produce a more aesthetically pleasing breast shape for immediate reconstruction patients.Finishing Touches
Tissue expanders are built to be strong and stretch out the muscle and the skin, but they are not soft enough to be comfortable permanent breast implants. For our patients in Corona, Irvine, and Newport Beach, breast implants – either saline or silicone filled – will replace the tissue expander after enough space has been created. The nipple and areola can be reconstructed in a subsequent procedure.

Implant Options

The tissue expansion technique for breast reconstruction involves slowly expanding the remaining skin on the chest over time, with the goal of replacing the removed breast tissue with an implant. After choosing the tissue expansion technique for breast reconstruction, our Orange County patients must next choose the type of breast implants. Today, the available choices are silicone gel or saline implants.One of the main differences between silicone and saline implants is how they feel to the touch. Many of our Corona, Irvine, and Newport Beach patients agree that silicone breast implants feel softer and more like natural breasts than saline implants. To learn even more information about breast implant options, visit Dr. Smith’s main plastic surgery site.

Safety of Silicone Implants
Silicone breast implants have been one of the most rigorously tested and studied medical devices in U.S. history. In 1992, the FDA imposed a moratorium on the use of silicone breast implants, except for women seeking reconstructive and revisionary surgery, while a clinical trial was performed to gather data about their safety. Dr. Andrew Smith was a participating investigator who gathered safety data for implant companies in the study.

After determining they were safe for general use, the FDA approved the use of a new generation of silicone gel breast implants in 2006 for use in elective breast augmentation surgery, as well as breast reconstruction surgery.

Flap Surgery

Because tissue expansion using breast implants is not appropriate for every Newport Beach breast surgery patient, flap reconstruction can be a viable alternative. For this Orange County breast surgery technique, Dr. Smith rebuilds the breast with a tissue flap of skin, fat, and muscle transplanted from another area of the body, such as the abdomen, buttocks, or back.Advantages and Disadvantages of Flap Surgery
As with the implant reconstruction technique, flap surgery has its own set of pros and cons. The advantages for our breast reconstruction patients from Orange County, California include a natural feeling reconstructed breast, made of living tissue that is not rejected by the body and does not need to be replaced. The disadvantages of flap surgery include a lengthy, complex surgery, additional scars at the donor site, and increased recovery time.Types of Flap Surgery
The variations of flap surgery depend on the location of the donor tissue and the way in which it is transplanted to the chest. Common methods include TRAM (Transverse Rectus Abdominus Muscle) and DIEP (Deep Inferior Epigastric Perforator), which use lower abdominal tissue; and latissimus dorsi, which uses back tissue. Dr. Smith will review your situation carefully and help you determine which method is most appropriate for you.

Let Us Help You
Dr. Andrew Smith has improved the lives of many Newport Beach mastectomy patients through reconstructive breast surgery. If you are facing mastectomy and considering reconstruction, he welcomes the opportunity to speak with you about the available options. Request a consultation online with Dr. Smith. You can also call our Irvine and Corona offices at 949.653.7000.

TRAM Flap

The TRAM (Transverse Rectus Abdominus Myocutaneous) flap breast reconstruction technique uses transplanted muscle, fat, and skin from a patient’s lower abdomen to reconstruct a breast that has been removed during a mastectomy. Because many women have excess abdominal tissue, this one of the most common techniques for breast reconstruction performed by Orange County plastic surgeon Dr. Andrew Smith.Dr. Smith is happy to talk with you about your options if you are facing a breast cancer diagnosis and are considering reconstruction. Request a consultation online with Dr. Smith or call our office at 949.653.7000 and a staff member will be happy to assist you.

TRAM Flap Methods
Patients who visit us in Orange County for breast reconstruction surgery have the option of the following methods for TRAM flap reconstruction:

Pedicle flap: This method preserves the tissue flap’s connection to its original blood supply by tunneling it under the skin to its new location on the chest. This method usually has the highest likelihood of success.

Free flap: The tissue flap used in this method is completely detached from its blood supply and reconnected using microsurgical techniques. Although this is a more complicated and time-consuming method than the pedicle flap, all areas of the transplanted tissue receive an abundant blood supply, resulting in a higher volume of healthy tissue. For many patients, the free TRAM flap can provide a more natural breast shape.

During your consultation, Dr. Smith will review breast reconstruction options with you and develop a treatment plan that is suited to your physical and emotional needs.

Benefits of the TRAM Flap
As with all autologous tissue flap techniques, a significant benefit of the TRAM flap is that the patient’s reconstructed breast is made with her own living tissue, so it will not be rejected by the body. Because excess abdominal skin and fat are used to recreate the breast, many women appreciate having a flatter abdomen as a result as well.

Nipple & Areola Reconstruction

During a mastectomy, the nipple and areola are typically removed, requiring a new nipple and areola to be created as a part of your breast reconstruction. During areola and nipple reconstruction in Orange County, California, Dr. Andrew Smith considers several factors to attain a natural looking result. Nipple size, position, projection and color all impact the final aesthetic appearance of the reconstructed breast, so size and projection will be discussed with you at the time of the procedure.Nipple and areola reconstruction are usually performed at the time when both you and Orange County breast surgeon Dr. Andrew Smith are happy with the final shape and size of your reconstructed breast. The procedure is performed in the operating room on an outpatient basis and is typically requires general anesthesia. Many women who visit Dr. Smith in Corona or Irvine for breast surgery choose this “finishing touch” for their reconstruction – click here to read Teri’s breast surgery story in which she talks about both breast and nipple reconstruction.

Recovering in Comfort
Nipple / areola reconstruction requires a recovery period, although it is much shorter than the previous steps in the process of breast reconstruction near Newport Beach. You can usually return to work within 2 to 3 days after the procedure. Pain medications are usually not prescribed and antibiotics will be administered intravenously in the operating room along with a topical antibiotic ointment to be used for 1 week after the procedure. Unfortunately, the new nipple will not have the sensation to respond to heat and cold.

Recreating Nipple Color
Tattooing of the newly created nipple and areola can be done 2 months after your procedure. The tattooing is performed in our office by a licensed esthetician using a topical anesthetic. The process usually takes 1 to 2 hours and you can return to work immediately. Color matching and shading of both the nipple and the areola are important, so our esthetician will work closely with you on what will give you the best results. Typically, tattooing is completed during a single appointment, but sometimes it may be necessary to have a second procedure to prevent color fading.

Preparing for Your Procedure

Once you have met with Orange County breast surgeon Dr. Andrew Smith for your initial consultation and have made your decision to proceed with breast reconstruction in Southern California, our office will begin coordinating with your general surgeon’s office regarding a surgical schedule. When the date is set, you will be notified by our office and/or your general surgeon’s office.Once the date of your surgery is finalized, you will be scheduled for a pre-operative appointment to meet with Dr. Smith and his surgical assistant, who is a registered nurse. This appointment is typically scheduled 1 to 2 weeks before your procedure. It is generally a good idea to bring someone with you to this appointment along with a list of any questions you may have concerning your Irvine breast surgery and the recovery period.

Your Pre-Operative Visit
At your pre-operative visit in Orange County for breast reconstruction surgery, Dr. Smith and his surgical nurse will be addressing important issues that will cover your post operative period and improve your healing process. You will be asked questions concerning your health, a list of medications your are currently taking, any medical problems you are being treated for now or have been treated for in the past, and a list of any allergies to medications, certain foods or latex. You will also be given instructions to follow before and after surgery such as:

Do not take any aspirin or aspirin-based products such as Advil, Motrin, ibuprofen, Excedrin, or Aleve 2 weeks before and up to 2 weeks after your procedure.

Inform us if you are taking any blood thinners, such as Plavix or Coumadin. It will be important for you to get medical clearance to stop these medications.

Let us know of any vitamin or herbal supplements you are taking, as some may interfere with your healing.

Smoking has a detrimental effect upon the body’s healing process. Ideally, complete cessation of smoking will maximize your ability to heal. If this is not possible, it is extremely important not to smoke 2 weeks prior to your surgery and for 2 to 4 weeks after your procedure.

You will be given prescriptions for pain medications and antibiotics to begin after surgery and when you are discharged from the hospital.

At the time of your pre-operative visit, you will be given information concerning admission to the hospital. You will need to pre-register in person and also have pre-admission testing performed before your surgery. Your general surgeon will be responsible for ordering these tests.

The Day of Surgery
No foods or liquids are allowed after midnight the night before your breast reconstruction surgery. You will need to arrange to have someone drive you to the hospital. You will be admitted to the hospital in the morning, depending on the time of your surgery, and you will usually stay 1 or 2 nights following your surgery.

Upon discharge, your recovery period begins. You will need to have someone drive you home from the hospital and to stay with you for the first few days after returning home. Also, you will need to have someone drive you to and from your post-operative visits at least for the first 7 to 10 days. Please be aware that you will not be able to drive for at least 7 to 10 days after surgery and until you feel confident enough to react to any situation that will avoid an accident and you are no longer taking narcotics for pain.

Potential Risks and Complications

The majority of mastectomy patients who choose to undergo breast reconstruction are satisfied with their decision. Breast reconstruction surgery carries with it potential risks and complications for our Irvine and Corona patients, as is the case with any major surgery. Dr. Andrew Smith will take the time to review your medical history and help you determine whether reconstruction is appropriate for you.General Risks
As with any surgery, our Orange County reconstructive breast surgery patients can experience general problems, such as bleeding, fluid collection, infection, excessive scar tissue, or difficulties with anesthesia. Fortunately, these problems are relatively uncommon. Smokers should be advised that nicotine can delay healing, so you should stop smoking prior to surgery. Dr. Smith will discuss this and other recommended precautions with you when you meet with him at your pre-operative visit.Implant-Related Risks & Complications
The complications associated with breast reconstruction for women who choose implant reconstruction are similar to those associated with cosmetic breast augmentation. For our patients in Irvine, Corona and Newport Beach, breast implants are associated with complications including:

Capsular contracture: The most common implant-specific problem is called “capsular contracture,” which is a hardening of the normal scar, or capsule, around the implant. This squeezing of the soft implant can cause the breast to feel hard. Capsular contracture can be treated in several ways, including surgically releasing the scar tissue, or replacing or removing the implant.

Implant leak: Our Newport Beach patients choosing breast implants should be aware that implants are temporary medical devices that will likely need to be replaced. While saline implants deflate rapidly when punctured or torn, silicone implants may show no immediate signs of rupture. For this reason it is recommended that patients with silicone implants have an MRI 3 years after implant surgery, and then every 2 years afterwards to monitor for leakage.

Shifting: Sometimes the implant can shift from its original location causing an unnatural look. This problem can be corrected through subsequent surgery.

Patient dissatisfaction: Although breast reconstruction with implants is the most common technique chosen, some patients are not happy with their results. Usually, removing the implants and replacing them with a different implant type or size resolves the patient’s concerns. Dr. Smith will do his best to give you realistic expectations for your breast reconstruction surgery so that you are pleased with your outcome.

Flap Surgery Risks & Complications
Flap surgery has the advantage of using your own living tissue to reconstruct the breast, but it also has its own risks and possible complications including:

Scarring: All types of flap surgery result in scarring, both on the newly constructed breast and at the donor site on your body. The scars will fade over time, but will never completely disappear. You will be more likely to be satisfied with this technique if you have realistic expectations for your results.

Tissue death: Since flap surgery uses transplanted tissue, there is the rare possibility of tissue death, or necrosis. If the transplanted tissue dies, it usually does so soon after surgery, in which case it will need to be removed.

As an Orange County breast surgeon, Dr. Smith also can explain in detail the specific risks associated with the various types of flap surgery at your consultation appointment.

Additional Considerations
Recovering from a breast cancer diagnosis and mastectomy is a gradual process, both physically and mentally, for many women. Initially, most patients are relieved to have the cancerous tissue removed and replaced with a reconstructed breast. However, many patients need some time to mentally adjust to the loss of their breast and to having the reconstructed breast as a part of their bodies.

If you have realistic expectations and understand that the new breast will not look, feel, or have sensations exactly like the original breast, you are more likely to be satisfied with your results. Breast reconstruction patients are usually happy they have had the surgery and report improved self-image, as well as increased self-esteem.

What to Expect after Surgery

Following your breast reconstruction in Orange County, California, a tight dressing of foam tape will be put on to help minimize swelling and to provide support and protection to your reconstructed breast. A small, thin drainage tube will be placed under the skin in your chest area to drain fluid and/or blood from the site of the operation. This drain will stay in place for at least 7 days and possibly up until 2 weeks depending on the amount of drainage. You will be instructed not to shower and to continue on your post-operative antibiotics until the drain is removed.You will also be discharged from the hospital with a “pain pump.” The pain pump is used to help ease post-operative discomfort and to reduce the need for narcotics. This pain pump will be removed during your first post-operative visit to our Irvine breast surgery office. You will be instructed on how to use your pain pump and it is important to remember that it does not take the place of narcotics. It is mainly to take the edge off of your discomfort.

You will return to our office within 2 to 3 days after your discharge. We will be removing all of your dressings, your pain pump and put you into a post-surgical bra. At that time we will review all of your post-operative instructions. Following Dr. Smith’s instructions is key to your surgical success.

Getting Back on Track
Healing will continue for several weeks to a few months. During this time you may periodically experience burning sensations, numbness, aching, and sharp pains throughout your surgical area. Most of this is due to the normal healing process. However, if you develop any unusual redness, a temperature and flu-like symptoms, you will be instructed to call our office immediately. These can be a signs of an infection.

It is important that your surgical incisions are not subjected to excessive stretching or movement during healing. Specific instructions will be given as you are monitored during your post-operative visits. Typically, you may return to your normal, daily activities after 4 to 6 weeks. More information about what to expect after surgery can be found on our breast reconstruction FAQs page.

For women who are having reconstruction using the tissue expansion method, we will begin gradual expansion of your tissue expander within 2 to 3 weeks after surgery and can schedule regular weekly appointments if that works best for you. After expansion is completed, you will need to wait a minimum of 2 months before the next stage of your breast reconstruction in Orange County can be performed. If you are having chemotherapy, you can still have your expanders filled but you will have to wait a minimum of a month after chemotherapy ends before you are able to continue your next stage of reconstruction. Chemotherapy typically lasts 4 to 6 months.

Real Patient Stories

New Meaning to the Term Survivor
“I was diagnosed with breast cancer at one of the most challenging times in my life,” says Lori. “My daughter, who had been a runaway, had just returned home, and I had just started a new job a month earlier.” Lori found the lump herself, and was devastated when her results came back positive. Read more…Teri’s Orange County Breast Surgery Experience
“I developed early in life and was used to having large, remarkable breasts,” says Teri. “They were a big part of who I was, who I had always been.” But when diagnosed with breast cancer, Teri’s top concern was survival, and saving her breasts became a secondary issue. Read more…

Lisa’s Breast Reconstruction Story
“While cancer did run rampant on my mom’s side of the family, I was only 39 and this kind of thing just couldn’t be happening. I was one of those, “It’ll never happen to me” people. Well it did.” Read more…

Her Reconstruction Was “Just as She’d Hoped”
“After losing her mother, 3 aunts, 2 cousins and her father to cancer, this patient, who we’ll call “Jane” to protect her anonymity, was determined to be a survivor. She had a long and challenging journey, however, from the discovery that she was at high risk for breast cancer to her breast reconstruction in Orange County.” Read more…

Answers to Common Questions

If you are facing mastectomy and considering breast reconstruction in Orange County, California, it is understandable that you have many questions. Dr. Andrew Smith believes it is important that you feel comfortable talking openly with the plastic surgeon you choose to perform your breast reconstruction so that you feel confident about the decisions you make and all of your concerns are addressed prior to surgery.Why do women choose breast reconstruction?
Women choose breast reconstruction in Southern California for very personal and individual reasons. If you choose breast reconstruction, it is important you do so with realistic expectations. Some common reasons include:

Preventing the emotional strain of seeing yourself without a breast

Enhancing self-esteem, body image, and confidence

Restoring a balanced look to the chest, both in and out of clothing

Feeling more sexually attractive

Avoiding the inconvenience and discomfort of wearing a prosthesis

Will my breast reconstruction be noticeable?
Without clothing you will be able to see the difference between your reconstructed breast and your natural breast. However, when you are wearing clothing, even a swimsuit or a bra, your breasts will likely be similar enough in size and shape that your reconstruction will not be noticeable.

Will my reconstructed breast also have a nipple?
Yes. The nipple and areola are usually removed during mastectomy, but they are commonly reconstructed in an additional outpatient procedure performed some time after the reconstruction surgery.

What options do I have for breast implants?
Women considering breast reconstruction have several choices to consider for their Orange County breast implants. Once a sufficient pocket has been created through tissue expansion, a silicone gel or saline implant can be placed in the breast. Dr. Smith will carefully review your implant options with you if you choose this reconstructive method.

Does breast reconstruction interfere with cancer treatments?
Having your breast reconstructed immediately after mastectomy has not been shown to affect subsequent cancer treatments, such as radiation and chemotherapy. Sometimes, I will recommend delaying these treatments until you have sufficiently recovered from the reconstruction surgery. I do recommend using a radiology center experienced with reconstructive breast surgery patients for future mammograms.

What is the breast reconstruction process like?
Every woman has a unique experience with breast reconstruction. However, if you do the research and talk with other women, you can begin to get a sense of common aspects of this procedure, including surgical options and steps to recovery. Dr. Smith has many satisfied patients who would be happy to share their stories with you – ask for more information during your consultation. In the meantime, you can read Teri’s breast surgery story to hear one patient’s perspective of her experience.

What can be done if I don’t like my reconstructed breast?
It is important that we have open and clear communication about breast reconstruction results prior to your surgery to give you realistic expectations about the outcome. While I strive for natural and realistic looking results, a reconstructed breast will not look or feel exactly like a real breast. Once you have your surgery, you will need to wait for several months for the results to achieve their final shape before you will know how your new breast will look. If you end up with concerns, I will be happy to meet with you and discuss the options for modifying your reconstructed breast.

Vectra® 3-D Imaging

Trying to visualize how you'll look after plastic surgery can be challenging. You can check out a surgeon's before-and-after photos, talk with friends who've had similar procedures, and even leaf through magazines filled with pictures of surgically enhanced stars. But when it comes to getting the reassurance you need about a potentially life-changing decision, there's no better option than VECTRA 3-D cosmetic plastic surgery imaging in Orange County.